Risk Bearing Organizations (RBO) – Financial Report Results

The chart lists the RBO (provider identification number, name, region, county and reporting period) and whether the RBO has 'met' or 'not met' the five grading criteria (maintained positive working capital at all times; maintained the required cash-to-claims ratio; maintained positive TNE at all times; calculated and documented IBNR; and reimbursed, contested or denied at least 95 percent of its claims within 45 working days). In addition, the Relative Working Capital and TNE ratios are calculated (by the Department) for each RBO.

The RBOs reporting deficiencies in any of the five grading criteria are required to implement, with agreement of its contracting health plans and the approval of the DMHC, a corrective action plan to remedy the deficiencies.

The RBOs that serve less than 10,000 covered lives under all risk arrangements as of December 31 of the preceding calendar year are required to file disclosure statements indicating if they have met or not met the Grading Criteria (listed above). Based on the information submitted, the Department can require the RBO to file Quarterly Survey Reports for additional information about the RBO's financial status.

The chart below contains the self-reported information from the disclosure statements ('Compliance Statements') received for RBOs with less than 10,000 lives. It summarizes whether the RBO has 'met' or 'not met' the Grading Criteria and if the RBO was provided written notice to file Quarterly Survey Reports to the Department.